a University of North Carolina at Chapel Hill.
Am J Bioeth. 2016 Nov;16(11):3-12. doi: 10.1080/15265161.2016.1222007.
Governments must determine the legal procedures by which their residents are registered, or can register, as organ donors. Provided that governments recognize that people have a right to determine what happens to their organs after they die, there are four feasible options to choose from: opt-in, opt-out, mandated active choice, and voluntary active choice. We investigate the ethics of these policies' use of nudges to affect organ donor registration rates. We argue that the use of nudges in this context is morally problematic. It is disrespectful of people's autonomy to take advantage of their cognitive biases since doing so involves bypassing, not engaging, their rational capacities. We conclude that while mandated active choice policies are not problem free-they are coercive, after all-voluntary active choice, opt-in, and opt-out policies are potentially less respectful of people's autonomy since their use of nudges could significantly affect people's decision making.
政府必须确定其居民通过何种法律程序注册或可以注册为器官捐献者。只要政府承认人们有权决定在死后自己的器官如何处置，那么就有四种可行的选择：选择加入、选择退出、强制积极选择和自愿积极选择。我们研究了这些政策利用推动因素来影响器官捐献登记率的伦理问题。我们认为，在这种情况下使用推动因素在道德上是有问题的。利用人们的认知偏见是对他们自主性的不尊重，因为这样做涉及绕过而不是参与他们的理性能力。我们的结论是，虽然强制积极选择政策并非没有问题——毕竟它们是强制性的——但自愿积极选择、选择加入和选择退出政策可能对人们的自主性的尊重程度较低，因为它们使用推动因素可能会对人们的决策产生重大影响。
